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MEDICATION / TREATMENT

ADMINISTRATION GUIDELINES

Duval County School Health Services Manual

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The practice of administering medications in school is governed by several areas of Florida Law. The administration of any medication in school is discouraged, unless absolutely necessary to optimize a student’s health and ability to attend school. Except in the case of emergency medications, parents and guardians are requested to administer a student’s medication before or after school, safely at home. The school has the right to refuse to administer medication that is not required to be given during the school hours. The School Nurse will provide the parent with information to so that the parent can discuss adjusting the timing of medication administration with the prescribing physician. Unlike some school districts, Duval County Public Schools (DCPS) do not have a nurse present in each school. Therefore, the responsibility of administering medication to students is legally delegated, as per the Florida Nurse Practice Act, by a Registered Nurse to a DCPS school staff-person. The designated DCPS staff is trained by RN’s annually. Because DCPS staff has multiple duties and tasks in a school, in addition to administering medication, cooperation of all involved persons is needed at every step of the process to run smoothly and safely. Parents and guardians, not nurses or school staff, are ultimately responsible for ensuring that their students are receiving medications at school as expected and ordered, that medication guidelines are being followed, medications are not expired, supplies from home are available, unused medication is picked up, documentation is complete, health and medication changes are communicated, that their student has been educated about the student’s personal responsibilities when taking medication at school, and that a current phone contact number is available on the emergency contact list. Guidelines for administering medication in Duval County Public Schools are strictly enforced to adhere to professional best-practices that ensure a student’s safety. Lack of cooperation with or not following the Guidelines for Administering Medication will result in the District’s or School’s inability to administer medication to a student. Guidelines for Administering Medications at School

Medications will be administered under this policy in schools only during regular business school hours. Parents or guardians of children attending before or after-school programming must make arrangements with those specific programs for administration of medication according to that program’s protocols and policies.

Parents or guardians can administer their student’s medications in schools.

Parents or guardians are responsible for transporting medication to and from school with direct delivery to an authorized school staff person.

No medication will be transported by a student to school except those students who have prior approval to self-carry ordered medication.

No medication will be transported via the school bus system except those students who have prior approval to self-carry ordered medication.

Parents must provide all medication and required supplies before any medication is given.

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Medications classified as narcotics will not be administered in Duval County Public Schools general education settings.

All student medication requires a label with the student’s name, dose, and the approximate time medication is to be administered at school, physician’s name and medication expiration date.

The first dose of a newly prescribed medication must be given at home, not at school due to the possibility of an allergic or adverse reaction.

Medication Authorization forms are completed and signed by parent or guardian and physician for each medication given and each time any change occurs. See directions below.

Any child discovered with unidentified medication or sharing medication with other students will be subject to DCPS School Board policy regarding discipline for having unauthorized drugs on his or her person.

New medication delivered to a school must be in its new vial or container with required label information. Older, unused medication cannot be mixed or transferred to a new bottle.

Medication for weekends and holidays at home should be removed from the newly filled prescription and maintained at home before the medication is delivered to the school. An empty medicine bottle with an exact second label can be requested from the pharmacy at the time the prescription is filled.

The amount of medication delivered to the school should not exceed at 30-day supply for prescription medication.

If half-doses of a tablet have been prescribed, the pharmacist or parent/guardian must break medication tablets in half at home before bringing to the school.

Nonprescription or Over the Counter (OTC) Medications

As with prescription medications, nonprescription medications (not from a pharmacy) may be given by trained staff at school if ordered by a physician. The medication must be clearly marked with the student’s name, dose, and the approximate time medication is to be administered at school, physician’s name and medication expiration date. Medication will be administered according to dosing instructions on the container unless the physician has ordered differently.

Permission to Administer Medications

For each individual medication administered, the student’s parent or guardian must provide the school principal or designee a completed Permission for the Administration of Medication form (attachment I-I) which allows the principal, trained designee or nurse permission to administer the medication during the regular hours of school day, including when the student is away from school property on official school business.

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The permission form is kept in a file or notebook in the area where the medication will be administered.

At the end of the school year or when the administration of medication is terminated, the permission form and the medication administration record (attachment I-II) should be filed in the student’s Cumulative Health Record.

Emergency Medications

Glucagon, Diastat and Epinephrine are the only emergency injectable medications that will be administered in schools by nursing or trained school staff.

Students Authorization to Self-Carry Medication

In order for a student to carry and self-administer medications at school and a

completed Permission for the Administration of Medication form must be signed by

the parent or legal guardian and physician as required by all medications. There is a portion at the bottom of the form that must also be completed by the parent or legal guardian, the student, and the physician.

This completed Permission for the Administration of Medication must be returned to the school before the student is allowed to carry self-administered medications.

The school is not responsible for documentation of medication use or monitoring of expiration date, if a medication is carried and self-administered by the student.

Storage and Disposal of Medication

All medication should be counted and stored in a locked cabinet, within a locked health room.

If medication must be refrigerated, it must be stored in a refrigerator in a limited access area. The refrigeration temperature should be maintained at 34-46 degrees F. A daily refrigerator temperature log (attachment I-IV) will be maintained.

Parents or legal guardians are requested to pick up expired medications when contacted. Medications not picked up will be destroyed within 2 weeks of notification according to recommendations of the Florida Department of Environmental Protection provided below.

Expired medications awaiting pick-up or disposal will be stored separately from other medications in a locked cabinet.

At the end of the school year medication not picked up will be destroyed after the last day of school.

Medication disposal should always be witnessed by a second person and documented by both people involved.

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The Florida Department of Environmental Protection (DEP) advises against flushing medications down the toilet through the municipal sewerage system. This practice contaminates the environment and wastewater treatment systems are not designed to remove many of these medications.

The following procedure is will be used:

1. Keep the medicines in the original container.

2. Mark out the name and prescription number for safety.

3. For pills: add some water or soda to dissolve them

4. For liquids: add something inedible like cat litter, dirt or cayenne pepper.

5. Close the lid and secure with duct or packing tape.

6. Place the bottle(s) inside a non-see-through container like a coffee can or plastic laundry bottle.

7. Tape that container closed.

8. Place container inconspicuously in the trash. Do not dispose of any containers with medications in the recycle bin.

9. Metered dose inhalers should be emptied outdoors by pumping the container into the air,

as if being administered.

10. Injectable medications can be emptied into absorbent material and disposed in the trash according to the procedure described above, with the empty containers being placed in the sharps disposal container.

11. Additional information can be found on the DEP web page, How to Dispose of Unwanted Medications.

Personnel Authorized to Administer Medications

Only school employees who are delegated to administered medication and have received annual DCPS medication administration training may administer medication to students.

Per F.S. 1006.062 (2), there shall be no liability for civil damages as a result of the administration of medication where the person administering medication acts as an ordinarily reasonable, prudent person would have acted under the same or similar circumstances.

Authority

Florida Statute 1006.062 authorizes school personnel to assist the student in the administration of prescription medications.

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Documentation of Medication Administration

A standardized DCPS medication log with be maintained in each school for recording student medications. At such time the FOCUS SIS electronic record becomes accessible, medications will be documented in each student’s electronic record.

The trained person administering the student’s medication will initial the standardized Medication Administration Record (MAR) after each dose of medication.

Guidelines for Administering Medications

THE 6 R’S RIGHT STUDENT RIGHT TIME

RIGHT DOSAGE RIGHT MEDICATION RIGHT ROUTE

RIGHT DOCUMENTATION

1. Wash your hands.

2. Work in good lighting.

3. Concentrate on what you are doing when working with medications.

4. Make certain you have a written order for every medication you give.

5. Check record to make sure child has not already received medication for that time or day.

6. Check label three (3) times:

a. When taking medicine from storage

b. When preparing/pouring medicine

c. When placing medicine in storage

7. Make certain that the data on the medicine request sheet corresponds exactly with the label on the child’s medicine.

8. Never give medicine from an unlabeled container or from one which the label is not legible.

9. Make proper identification of the child – ask for name, rather than “are you ______?”

10. Watch the child take the medicine.

11. Never chart a medicine as having been given until it has been administered.

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12. Pour tablets/capsules into the bottle cap and then into the child’s hand or medicine cup.

13. Pour liquids opposite the label to prevent drips from obscuring the directions. Wipe the rim of the bottle before replacing the cap.

14. Do not leave medicine unattended.

15. Store drugs as recommended:

d. Refrigerate.

e. Store away from heat or light.

f. Keep tightly closed.

Procedures for Administering Medication Oral Medications

Student should assume sitting or standing position.

Pour the tablet from the bottle into the container lid, then into the medicine cup, as necessary.

Pour liquid by setting medicine cup on a firm surface at eye level and read fluid level at the lowest point of the meniscus (curved upward surface of the liquid in a container). Place lid upside down to avoid contamination and pour with label facing up to avoid obliterating label. Wipe bottle off before replacing cap.

Return medication to cabinet or refrigerator. Lock cabinet.

Unless contraindicated, offer a fresh glass of water to aid in swallowing to camouflage the taste of bitter medication, and to assure that medication is washed into the stomach.

Make sure the student swallows the medication.

Discard used medicine cup.

Record the medication on the appropriate forms.

Observe student for any immediate medication reaction or side effects.

Topical Medications (ointments & salves)

Gather necessary equipment including gloves or tongue depressor as needed.

Squeeze medication from a tube, or using a tongue depressor, take ointment out of jar.

Spread a small, smooth, thin quantity of medication evenly on bandage to be placed on skin. Use a tongue depressor to facilitate the smooth application of ointment.

Protect skin surface with a dressing and use tape or gauze to secure in place.

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Remove gloves and wash hands.

Return medication to the medication storage cabinet. Lock cabinet.

Record medication on the appropriate forms.

Observe student for any immediate medication reaction or side effects.

Eye Medication – Eye Drops

Explain procedure to student.

Give tissue to student for wiping off excess medication.

Have student tilt head slightly backward and look up.

Squeeze the prescribed amount of medication into the dropper. Hold dropper with bulb in the uppermost position.

Place eye-dropper ½ to ¾ inch above eyeball with dominant hand.

Stabilize the hand holding dropper as necessary. Place other hand on cheek bone and hand holding the dropper on top.

Expose lower conjunctival sac (mucous membrane that lines eyelids) by pulling down on cheek.

Drop prescribed number of drops into center of conjunctival sac.

Repeat procedure if student closes eye and drops fall on eyelid.

Ask student to gently close eyelids and move eye to assist in spreading medication under the lids and over the surface of the eyeball.

Remove excess medication with clean tissue.

Wash hands.

Replace medication in medication cabinet. Lock cabinet.

Record medication on the proper forms.

Observe student for any immediate medication reaction or side effects.

Eye Medications– Eye Ointment Same as above except for the following application:

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Gently separate patient’s eyelids with thumb and two fingers and grasp lower lid near the margin of the lower lid immediately below the lashes. Exert pressure downward over the bony prominence of the cheek.

Student should look upward.

Apply eye medication along the inside edge of the entire lower eyelid, starting at the inner corner.

Ear Drops

Position student on side, with ear to be treated in the uppermost position.

Fill medication dropper with prescribed amount of medication.

Prepare student for the instillation of ear medication as follows.

Child: Lift ear upward and outward.

Instill medication drops, holding dropper slightly above the ear.

Instruct student to remain on side for 5-10 minutes following instillation.

Nose Drops

Student should be in a sitting position with head tilted back, or in a supine (lying on back) position with head tilted back over a pillow.

Fill dropper with prescribed amount of medication.

Place dropper just inside the nostril and instill correct number of drops.

Instruct student not to squeeze the nose and to keep head tilted back for five minutes to prevent medication from escaping.

Return medication to the medication storage cabinet. Lock cabinet.

Record the medication on the appropriate forms.

Observe student for any immediate medication reaction or side effect.

Injectable Medications

Only RN’s are permitted to administer injections, except for other disciplines who are trained and designated by an RN, an LPN, a physician licensed pursuant to Chapter 458 or 459 or a physician assistant licensed pursuant to Chapter 458 or 459 of the Florida Statutes to administer the Epinephrine or Glucagon for students who need them in an emergency situation.

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Medication Not Administered

If the student fails to report to the health room for his/her medication, the health room designee will make every reasonable effort to locate the student and give the medication, but if this fails, the health room designee shall not be held liable for the missed dosage. The reason for the missed dose should be documented on the student’s Medication Administration Record.

The parent or legal guardian will be notified at the contact information provided on the emergency card.

If the student shows a pattern of not reporting for medications the RN assigned to the school will be notified.

Medication Error / Variance

Violation of any of the 6 Rights of Medication Administration is considered a medication error or variance requiring completion of a Medication Variance Report (attachment I-VI).

If a student receives an incorrect drug or dosage, the Principal or designee, parent, and Registered Nurse must be notified immediately so that the appropriate intervention can be initiated.

When a student does not report for a medication the staff will make a reasonable effort to locate the student in the classroom to which they are assigned.

When a dose is missed the parent with be contacted at the contact phone number on record and a variance report completed.

If multiple doses are missed the parent or guardian will be contacted with a request to reeducate a student about their responsibility in receiving medication at school. The Principal will be notified if additional assistance is needed.

Medication Administration on Field Trips

Refer to the Duval County Public School Field Trip Handbook (attachment I-V) for complete instructions.

It will be the health room designee’s responsibility to prepare all medications for field trip administration. Therefore that assigned staff will need to be aware of all field trip times, etc.

All medication leaving the school campus during school hours or after school on a school-sponsored activity must be in its original container and accompanied by a copy of the Medication Administration already in use. One medication form is used per medication. The copy is attached to the original upon return to school.

A DCPS staff member who has taken the medication training (preferably a teacher or principal’s designee) will be responsible for issuing the medication at the appropriate time.

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This CANNOT be a parent chaperone. The time of medication administration must be put on the medication form at the time administered, not before or at the end of the day upon return to campus.

The medication must be transported in a locked container (tackle box, bank bag, etc.) The container MUST be LOCKED! It cannot be transported in a purse.

IT IS VERY IMPORTANT FOR CHILDREN WHO HAVE GLUCAGON, EPINEPHRINE OR INHALERS ORDERED FOR THEM THAT THEY BE CARRIED ON THE TRIP AND APPROPRIATE PERSONNEL BE TRAINED FOR THEIR ADMINISTRATION. PLEASE NOTE THAT THE SCHOOL NURSE NEEDS TO BE NOTIFIED OF THE FIELD TRIP EARLY ENOUGH THAT TRAINING CAN BE DONE PRIOR TO THE FIELD TRIP. THE NURSE IS NOT AT THE SAME SCHOOL EVERY DAY AND NEEDS TO MAKE ARRANGEMENTS FOR THE TRAINING TO BE COMPLETED.